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TEMPLE UNIVERSITY<br />

A Commonwealth University<br />

Center for Public Policy Gladfelter Hall, 10th Floor (025-02)<br />

12th St. and Berks Mall<br />

Philadelphia, Pennsylvania 19 122<br />

’ (21 5) 204-6696<br />

Fax: (2 15) 204-7779<br />

Subject Consent Form<br />

Participant’s Name:<br />

Project Title:<br />

(Please Print)<br />

Evaluation of Prison Based Drug Treatment in Pennsylvania: A Research Collaboration Between The<br />

Pennsylvania Department of Corrections and the Center for Public Policy At Temple University<br />

Investigators:<br />

Wayne N. Welsh, Ph.D.<br />

Associate Professor, Department of <strong>Criminal</strong> <strong>Justice</strong><br />

5th Floor, Gladfelter Hall (025-02)<br />

Temple University<br />

Philadelphia, PA 19 122<br />

Purpose<br />

The purpose of this research study is to evaluate the effectiveness of drug and alcohol education and<br />

treatment programs provided by the Pennsylvania Department of Corrections (DOC).<br />

Benefits<br />

I understand that I will be given the opportunity to request a summary of the study results. The<br />

information collected from this study will help DOC to assess the effectiveness of its current programs<br />

and improve the quality of drug and alcohol programming offered to inmates.<br />

General Research Procedures<br />

By giving my consent to participate, I understand that Temple researchers will have access to my DOC<br />

drug and alcohol treatment records and my DOC institutional records. To examine long term outcomes<br />

of treatment (e.g., drug relapse or recidivism), researchers will seek access to Department of Probation<br />

and Parole records and state criminal records for up to two years following my release from DOC<br />

custody. I understand that researchers may ask me to complete a survey and/or interview asking about<br />

my experience in this program. I understand that I may refuse to participate in a survey or interview at<br />

any time.<br />

ICONTINUE TO OTHER SIDE1<br />

Page 1 of 2<br />

This document is a research report submitted to the U.S. Department of <strong>Justice</strong>. This report has not<br />

been published by the Department. Opinions or points of view expressed are those of the author(s)<br />

and do not necessarily reflect the official position or policies of the U.S. Department of <strong>Justice</strong>.

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